Virginia Claims or Coverage Denials

CareFirst Virginia Members may request an external review of any denied claims or coverage by the Virginia State Corporation Commission.

If you have CareFirst health insurance in Virginia, you may visit the Virginia State Corporation Commission website to obtain forms and resources to submit a request for an external review on claim and coverage denials occurring after July 1, 2011.

Details on what types of coverage and adverse benefit determinations are eligible for this request, as well as information on how to make the request, are located on the Virginia State Corporation Commission website.

Note: Virginia members who wish to appeal an adverse benefit decision that is related to the treatment of cancer may be entitled to an expedited external review without first exhausting the internal review process.

Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (Used in VA by: First Care, Inc.). First Care, Inc., CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc. and The Dental Network are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

CareFirst of Maryland, Inc. and The Dental Network underwrite products in Maryland only.

“World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.